Forms

If we’ve already connected and you’re paying for your service(s) via e-transfer, please open and submit the correct form by clicking on a button below. If you have booked a Distant Reiki session, please email me with a photograph of you or your pet as well.

Reiki/Crystal Healing

Reiki/Crystal Healing Form

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

Country

(###)

###

####

Referred by:

Do you have areas within your body that you feel tension or pain?

Describe the problem(s) for which you are looking for help:

Please list any feelings you experience on a regular basis (ie: annoyed, anger, sadness, fear, guilt, etc.)

Disclaimer:

I understand that Reiki/Crystal Healing is a stress reduction and relaxation technique. Reiki/Crystal Practitioners do not diagnose conditions, nor do they prescribe substances or perform medical treatment, nor interfere with the treatment of a licensed medical professional. It is recommended that I see a licensed physician, or licensed health care professional for any physical or psychological ailment or condition I may have. I also understand the body has the ability to heal itself, and to do so complete relaxation is often beneficial. Long-term imbalances in the body require multiple sessions to allow the body to reach the level of relation necessary to bring the system back into balance. I understand and believe that self improvement requires commitment on my part, and that I must be willing to change in a positive way if I am to receive the full benefit of Reiki/Crystal Healing sessions. I acknowledge my commitment to my self-improvement process. I recognize that a Reiki/Crystal healing session program must be followed to be truly effective, just as a prescribed medication is only effective if taken as directed.

Yes, I have read and understand the information above.

Pet Reiki

Pet Reiki Form

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

Country

(###)

###

####

Referred by:

Subject

Message

Pet's Name

First Name

Last Name

Breed

Age

Please list any health concerns:

Please list any medications your pet is taking and for what:

What type of food does your pet eat?

Pet's medical history:

Your pet's personality:

Pet's behaviors/habits:

Does your pet exercise? How often?

Please list what you are looking for help with:

Disclaimer:

Reiki is not a substitute for Veterinary care and does not diagnose, treat or prescribe medications. If your pet has a health concern you should always contact your Veterinarian.

Yes, I have read and understand the information above.